Saturday, 16 October 2010

Religion and Public Health: Strengthening the Response to Preventable Diseases through Education

The following keynote address was delivered at the National Conference on Religion and Public Health in Stellenbosch on 6 October 2010.

Ladies and Gentlemen, Honoured Guests, dear friends, it is good to be with you this morning, as joint patron of this Conference, along with Dr Aaron Motsoaledi, South Africa's Minister of Health. I am grateful for this opportunity to address the vital relationship between ‘Religion and Public Health’, and in particular to consider how those of us from the faith communities can play our part in ‘Strengthening the Response to Preventable Diseases through Education’. My perspective is particularly through the lens of Judeao-Christian tradition, though I hope what I shall say has wider application among the faith communities.

May I begin by expressing my thanks to the National Religious Association for Social Development; to Fr Richard Menatsi (Chairperson) and Sheik Ahmed Sedick (Vice Chairperson); to Dr Renier Koegelenberg (Executive Secretary), and Canon Desmond Lambrechts (Director of the Public Health Programme); and all who have worked with them, in their organising, and generous hosting, of our time together. We look forward to Dr Motsoaledi joining us later today, so that our conversations and debates around these vital topics can be further broadened and deepened.

From the perspective of Anglicans in Southern Africa, there could hardly be a more auspicious day to meet, for today in the Anglican calendar of saints and heroes of the faith, we remember Henrietta Stockdale – also known as Sister Henrietta, who laid the foundation of professional nursing and modern hospital organisation in Southern Africa. The daughter of an English clergyman, she came to South Africa in response to a plea for teachers and nurses, having first trained in London. In due course, she established Southern Africa’s first training school for nurses in Kimberley, and those she taught also went on to found other training schools across the region. Her conviction of the need for proper authentication of qualifications resulted in the Cape of Good Hope Medical and Pharmacy Act of 1891, which provided for the first state registration of nurses and midwives in the world. She died on this day in 1911.

As I address the specific topic of ‘The contribution of religious networks to primary health care: challenges and expectations’, Sister Henrietta is just one vivid example of how faith communities have been engaged in delivering health care of one sort or another, through the changing circumstances of the world over many centuries. Care and compassion towards those in need, including the sick and suffering, has been a touchstone of most faiths, since ancient times. In the Hebrew Scriptures we read of the prophets denouncing the leaders of the nations as shepherds who fail the flocks entrusted to their care, since they have not ‘strengthened the weak, healed the sick, and bound up the injured’ (cf Ezek 34:4). In the Bible, Jesus tells his followers that whoever tends those who are ill are effectively caring for him – and whoever fails to offer such help stands condemned (Matt 25). Historically, precursors to what we would recognise as hospitals were found in antiquity, but their emergence as we know them today was most strongly influenced by the care provided by the Christian churches, monasteries and religious orders in Europe.

Even now, when the ultimate responsibility for the health sector rests with governments, faith communities remain deeply involved in the delivery of primary care. It was recently estimated by the World Health Organisation that almost half of health services in sub-Saharan Africa are provided by churches. Other faith communities are similarly engaged across the world. And where governments take the major role, as Sister Henrietta’s example demonstrates, today’s health care systems are often historically influenced by the faith communities.

But we are here today to consider not the past, but the present and the future, and to focus our energies, our imaginations, on what can we can do here and now to help make a difference to the health of our country. In doing this, I want to suggest that we as the faith communities ask ourselves three questions: What is the Content that we need to address over the next two days? What are the Processes that we want to suggest for engagement of the faith communities with the Health Ministry? What are the Values that we can particularly bring to the table?

Content

When it comes to the Content of the challenges of the health sector, our starting point can only be that we are not doing as well as we ought, as a nation. Of course, we live with the distorted heritage of the past, when world-class care was provided to the few, while the many were left with far less than adequate provisions. But we are not prisoners of the past, and cannot use our legacy, dismal though it was, as an excuse for not doing better today.

As I prepared to come here, I was fascinated to read the timely piece by Anso Thom in the Cape Times on Monday, and further references to Minister Motsoaledi yesterday. These spoke about the disjunction between our relatively high spending per capita, and the levels of health our country enjoys – or, rather, fails to enjoy. Some of the problems we face are well known, certainly at the level of newspaper head-lines. We know about the high levels of HIV and AIDS, and of TB, in South and Southern Africa, and of the way the two are so often linked. We know of the problems of malaria. We also know of the problems of service delivery in hospitals and clinics. We know of the high level of maternal and infant mortality rates, and South Africa’s very poor record in pursuing the Millennium Development Goal to reduce this. Beyond our borders the challenges are often wider and greater – cholera in Mozambique, for example. My brother bishop in the southern part of Mozambique also commented that, tragically, traffic accidents ‘compete’ with disease when it comes to causing death and injury. Poverty also increases the ability of individuals to access care, and of governments to reach their people. This can be a significant problem in relation to family planning and the treatment of chronic conditions including epilepsy, as well as for ARV provision and TB medication.

But there are other ills of which we are perhaps less aware. I was shocked to learn recently that the Department of Water and Environmental Affairs acknowledges that in South Africa over 100 children may die daily from diarrhoeal diseases, largely a result of poor water and sewage provisions. Adequate sanitation can reduce the incidence of diarrhoeal diseases by up to 40%. Poverty can exacerbate health problems in so many other ways – not least in the lack of basic education about good health practices. We need to ask ourselves some hard questions: Why does HIV continue to spread at unacceptable levels? Why is TB, entirely treatable, so prevalent? Why are people so passive, defeatist, in the face of illness, often only going to clinics when they are seriously unwell? Why do so many of us follow life-style practices that increase the risk of us developing serious, even life-threatening, conditions including diabetes, heart disease, and cancer – when so many of these are largely unavoidable?

Monday’s Cape Times article was titled ‘Prevention is much better than cure’, and I am delighted that education for disease prevention is such a priority for the Health Minister. I hope I will have an opportunity to speak to him after his arrival to express appreciation for all he is doing to turn around the Health Department, and to focus energies and resources in areas that can make the biggest difference at the most basic levels of disease prevention and care. I also want to pay tribute to the excellent supporting work that was done, all too briefly, by his deputy, Dr Molefi Sefularo, who tragically died earlier this year. I hope that the Minister will urgently appoint a new deputy who can provide similar strong assistance in driving the work of the ministry forward.

But the health challenges of this country, and the other nations of Southern Africa are greater than any of us can face alone, and therefore we must all contribute what we can to alleviating the burden. Primary health care has to be the place to start ‘eating this elephant, bite by bite’. This means we must tackle disease prevention, health promotion, swift effective treatment, and longer term evaluation, rehabilitation, and, where necessary, palliative care, and support for the terminally ill and their families.

Process

In many of these areas, the church has much to offer. This brings me to my second theme of ‘Process’. When it comes to preventing disease and its spread, and promoting good health, one of the most important components is education. Here faith communities have remarkable potential. While we are generally no longer in the business of providing medical professionals, we nonetheless most certainly do have remarkable capacities for communication with a very high proportion of the population of our country. We have, so to speak, a ‘reach’ that governments and political parties might envy. We must be intentional in using it well.

For we need to recognise and acknowledge that we have not always been wise. For too long, churches and other faith communities have not played a positive role in relation to education on HIV and AIDS. For too long we fuelled stigma, and with it ignorance and denial, all of which contributed to the disease’s spread. But as we learn to speak more openly, more honestly, more constructively, about these diseases and the factors around them, so we can help society as a whole to deal with them in this way. Let’s face it, the faith communities are never comfortable talking about sex, but we have no option but to do so, realistically, and holistically, and help change wider attitudes about what is too often something of a taboo subject.

One good news story comes from Khayelitsha, where Anglicans set up church-based HIV and AIDS support groups. Initially, we found that those who came were choosing to attend a group far from their home – they didn’t want to be recognised and identified and become the subject of gossip and speculation within their own communities. But now attitudes have changed – not only because of changing church attitudes, (though this has certainly been significant); but also through such factors as almost all pregnant women knowing their status, and this being seen as ‘normal’. We now find that people are far more relaxed about attending a group in their own community, far more relaxed about testing and knowing their status.

Making this transition from being part of the problem to being part of the solution has required first of all a commitment to ensuring our clergy are well-educated in the facts. Educating clergy and church leaders can enable us to do more on other health issues, in everything from nutrition to basic hygiene. Problems of gender-based violence and abuse, and emotional and mental health support, are other areas where our formal teachings – on Fridays, Saturdays, Sundays – must be well-informed. And while others may joke that clergy only work one day a week, we all know that there is a vast range of other activities within our parishes and congregations and communities, through which we can help educate and influence society.

Our communities can also provide effective support for good treatment compliance – people holding one another accountable for taking their medicines on time, and keeping up with their courses to the end of treatment. The persuasion of people-power is an area where we have vast resources at minimal cost.

We can also, as appropriate, partner with the Ministry in their formal education campaigns. Beyond that, while it is not our task to fulfil the Ministry’s responsibilities for them, there are surely many other ways we can support them in their aim of putting people first, the ‘Batho Pele’ initiative. Through our networks, our volunteers, our commitment to compassionate caring – and also through our physical presence in practically every settlement and community across our country – we have considerable capacity to act in constructive and cooperative partnership with those who have the skills and financial resources that we lack. Where necessary, for example, we can provide physical space for health professionals when they visit far-flung communities. Another example I might mention is the Siyafundisa Programme of the Anglican Church, where, in agreement with the government, we delivered US-funded peer education and life skills training to young people. I am sure that there are other examples that we will be able to share today and tomorrow.

Values

I have already touched indirectly on my third theme – the perspective on value, and values, that the faith communities can contribute within the health sector. This is perhaps where we have most to offer, as values, ethics, and the philosophical or moral context of what it means to be a healthy individual within a healthy community, are our ‘core business’. While Governments must uphold the ethos of Constitutions and the rights they guarantee to citizens – and in South Africa we are certainly blessed with having one of the best Constitutions in the world, when it comes to the rights of citizens – my belief is that it is civil society in its various forms, and particularly the faith communities, who bear the greatest responsibility for putting flesh on the bones, and giving shape, to the moral dimension of our societies.

For example, it is our care and concern for the whole human person, and for each individual as someone who ‘lives in relationship’ with their nearest and dearest as well as wider circle, that provides the context for health and well-being. We are the ones who can, and must, shape and support a prevalent mindset within our nation, so that we all operate automatically on the basis that medical treatment of physical maladies cannot be separated out from a wider concern for the person’s emotional and spiritual well-being.

As Christians, we root this in the belief that God created all humanity in his image; and that the second person of the eternal Trinity further dignified human existence by becoming incarnate in the man Jesus Christ. All people are intrinsically valuable in the eyes of God, intrinsically worthy of dignity and respect, no matter what their circumstances. It is well-documented that people generally respond more positively when they feel that they are respected and cared for in the whole of their being, on every level, in the attitudes of everyone from hospital receptionists through to medical staff.

Valuing also applies in other ways. We know that public sector budgets do not stretch to generous salaries. Nonetheless, faith communities can support a greater degree of respect and appreciation within the wider community for all those who work in this field; and, through this, help health workers from top to bottom feel a greater sense of value in the work they do – rather than feeling their work is to be evaluated purely in terms of financial reward. It is our desire that doctors, nurses, health professionals and all their support staff should find a deep degree of satisfaction through the difference they make to people’s lives; and should know themselves highly valued and appreciated within the wider community.

Promoting true values has another dimension, one that I am saddened that I have to mention – which is the need for the highest ethical behaviour within health management. There are far too many stories of corruption of one sort or another, particularly in relation to procurement of goods and services. (Of course these are not confined to the health sector.) It is the responsibility of the faith communities to give a clear, strong, lead in promoting an atmosphere of complete intolerance of corruption and malpractice of every sort. We must also give moral support and encouragement to the many within the public sector who do strive to uphold best practice and the highest ethical standards, and who, often at risk of their own jobs, are prepared to stand up against abuses. They deserve our wholehearted backing. We must look to ourselves also.

Caring for the whole person has other dimensions where the faith communities can extend the reach of the health care sector beyond what governments can provide. When I was 12 years old, my mother had TB, and spent 6 months in Rietfontein Hospital in Johannesburg. It was a very traumatic time for us, her children. Being part of a wider caring community is so vital in such circumstances – this is why church-based support groups and home care networks are so essential, and have such a significant impact where we run them. We must make our congregations aware that they need to be Christ’s compassionate eyes and ears in our communities, to ensure none in need are overlooked. A growing priority concern must be the identification of child-headed households, bringing them into contact also with social services who can provide help and support (and we can act in other ways in support of the Child Act). Sometimes a church person just going along as moral support to a clinic or government office, can make all the difference to an individual’s confidence in accessing the care they need and deserve.

We can also help ‘translate’ – in words, in practices – from the language of the professionals to those of local communities. For example, my sister, who worked in primary health care for 40 years, told me about how they had to walk sensitively alongside Traditional Healers, finding culturally appropriate ways for them to avoid reusing needles and razor-blades. We need to promote upholding best possible legal and ethical health practices in ways that have positive synergy with the lives of communities.

Let me mention a couple of particular concerns. One is that, rightly, governments seek to ensure consistent standards of care across countries. But the down-side can be that local initiatives are stifled. Worse, in some places, health services run by independent bodies, including the faith communities, are actually being closed down when they are not part of the uniform but limited, provisions that the government can supply.

There are also questions we must put to the business sector – even if they are not really part of our deliberations. But they too must consider values. Those industries with large work forces, and especially those with migrant labour, bear a heavy responsibility to be pro-active in promoting good health among their employees. I am glad that this is, at long last, beginning to be seen as increasingly normative. And business can go beyond this, and dare to consider the wider community from whom their workers are drawn – for we know that the average number of people supported by every person in employment can be very high.

We also need to encourage one another to think outside traditional boxes. In this respect, I am very glad that the Revd Paul Holley, will be speaking to us this morning on behalf of the World Health Organisation. He is director of the Anglican Health Network based in Geneva Switzerland. With the threat of aid cuts looming, they are looking at new models of healthcare funding. I hope he will share this with us.

And finally, of course, I must mention the care of the dying. As societies become increasingly urbanised, westernised, individualised, this becomes more and more of a taboo subject. The faith communities also have an ancient history to draw on, in this most challenging of areas – and our teaching can help people deal with the reality of human mortality, and face with honesty the last journey of life.

Conclusions

As I come to a close, I am glad to report that last week, at the Anglican Church in Southern Africa’s Synod, which we hold once every three years, tackling the challenge of health was one of 8 priority areas to which we committed ourselves in the decade ahead. Some of you who are here today were part of that debate and will help take our decisions forward in practical ways. It is my prayer that we will both learn from, and contribute to, the discussions of the next two days.

Finally, let me end with God – well, I am an Archbishop! – and with a word of encouragement. Though the challenges before us are vast, we know that God is on our side. It is his longing that all his children will find compassion, care, healing, and wholeness on the difficult journey of life. We can therefore be sure, that whenever we commit ourselves to these goals, it will be his joy and delight to support and strengthen us, to guide and encourage us, and to bless our endeavours, so that we may also be a channel of his blessing to others. May it indeed be so. Amen